Provider Demographics
NPI:1891573838
Name:OLIVER, RACHELGRACE JOY
Entity Type:Individual
Prefix:
First Name:RACHELGRACE
Middle Name:JOY
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1696
Mailing Address - Country:US
Mailing Address - Phone:315-463-9415
Mailing Address - Fax:315-214-8168
Practice Address - Street 1:960 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1696
Practice Address - Country:US
Practice Address - Phone:315-463-9415
Practice Address - Fax:315-214-8168
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health